Supporting the health and well-being of your teen begins with good communication

In this Q&A session, Richard Chung, MD, director of Duke’s adolescent medicine program, provides advice on some important teen health issues.

Is an annual exam enough, or should I bring my teen to the doctor more frequently?

For many adolescents, a yearly comprehensive examination in which their physical and mental well-being is fully assessed is adequate.

However, many adolescents come in for their annual examination with a laundry list of concerns that have accumulated over the course of the preceding year.

It would be better to seek care right when specific concerns arise during the year, because many issues can be resolved more effectively and efficiently if tackled earlier. Then the annual examination can focus on screening and routine health maintenance measures, which are crucial to preventive care.

What illnesses or conditions are teens least likely to seek treatment for, and how can I spot these conditions?

Contrary to the popular notion that all adolescents perceive themselves as invincible, the vast majority of them are quite concerned about their health and well-being.

However, many do not seek care despite feeling vulnerable.

Shame can be a powerful deterrent to seeking care for symptoms and concerns that might otherwise motivate a person to see a doctor. Teens are often ashamed about issues related to pubertal development, sexual health, and mental health.

These are common issues in adolescence, but many teens suffer in silence.

To ensure that illnesses are addressed early, good communication is crucial. Parents must try to engage their teenager in meaningful conversation at least once a day to demonstrate their care and concern and to get a sense of their teen’s general well-being.

It is challenging but definitely possible to gain insight into their lives through such conversations while also respecting their privacy.

Parents should explicitly affirm their teen’s privacy while also stating that no topic is out of bounds and that they will be supported regardless of what details they share. By setting such a standard, parents may be able to discover a teen’s distress early and help them seek care.

My teen is moody, and it seems to be getting worse. How can I tell if my teenager has an undiagnosed mental condition?

Significant mental illness is under-diagnosed, and one key factor may be the assumption that related symptoms are merely adolescent mood swings.

While healthy teens without illness do have strong and often fluctuating emotions, mental illnesses can present similarly or even in a more subtle form.

Parents should seek assistance from their physician when they or their teen have any concerns, especially if the symptoms are getting worse. For mental illness, which can be debilitating, it is difficult to overreact to suspicious symptoms.

My teen doesn’t like to talk about sensitive things. How can I speak to him about sexual issues?

Studies have shown that despite perceived awkwardness, adolescents do want to hear about sex from their parents. What they don’t want -- and what they fear will come out of such discussions -- is judgment and shame.

Discussing sexual issues effectively is challenging, even for physicians seeing adolescents in a medical office.

It’s all right to feel awkward. Most parents find the first mention of the topic most difficult, and follow-up conversations much easier. Parents should try to keep the initial discussion short and to the point, opening the door for subsequent dialogue.

Parents too often view discussion of sexuality as a one-time, intensive extravaganza (a.k.a. “the talk”). That approach is likely to be overwhelming and ineffective.

Whether via their friends, television, the Internet, or other avenues, adolescents are inundated daily with messages about sex and sexuality, many of which are distorted and unhealthy.

Given such a context, parents must realize the benefits of speaking effectively with their teen about sexual issues early and perhaps even regularly, and the serious risks of not doing so.

My teen doesn’t exercise at all. How can I get her to be more physically active?

All adolescents need a substantial amount of physical activity to maintain their health, whether or not they are overweight.

However, sedentary habits are commonplace among teens. A key first step is making physical activity easier to do. People adopt new behaviors when they both want to do those behaviors and believe those behaviors to be possible.

Starting with simple activities like walking is a good idea. Setting small and achievable goals early on can help an adolescent break sedentary habits and start momentum towards consistent exercise.

Exercising can take the form of dancing in one’s room, taking the stairs instead of the elevator, or even parking farther away from the shopping mall.

Taking a broad view of physical activity allows teens to accumulate a reasonable sum of activity over the course of the day, rather than planning discrete episodes of difficult and intimidating exercise.

After getting some momentum, they may be more agreeable to pushing themselves further.

Other ways to encourage activity and make sedentary habits harder to fall back into include parents exercising and staying fit, family physical activities, setting limits on screen time, and taking the TV out of the teen’s bedroom.

How can I encourage my teen to begin to take responsibility for his health?

This important aspect of adolescent development is sometimes overlooked by parents. As a result, many older teens and even young adults are not well equipped to effectively advocate for their health or seek care.

This is often an issue when young people struggle to transition from pediatric to adult care. It is helpful to establish the standard of caring for one’s body, even before adolescence. Gradually let the adolescent assume more responsibilities related to his or her health.

If a teen takes medications, transition responsibility for taking that medication to the teen over time.

Modeling by the teen’s parents also has a powerful influence. If parents have difficulty caring for their own health effectively, the adolescent may follow suit. On the other hand, positive efforts by a parent can set an important example